| NPI | 1972920098 |
|---|---|
| Former Legal Business Name | DIVINE MEDICAL WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | RANDALL LYNN ROULUND President 559-222-5362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2014-03-26 |